White Paper: The Cost of Opioid Use Disorder

Originally published by Avalere Health

Avalere Health finds opioid use disorder costs businesses, governments, and households almost $1 trillion per year, but treatment with medications can lower costs.

In 2022, over six million people in the United States reported having an opioid use disorder (OUD). Past research has not yielded comprehensive estimates of the full societal burden of OUD or the impact of OUD treatments in limiting associated costs. To evaluate the costs of OUD and the benefits and cost savings associated with OUD treatment, Avalere Health conducted secondary research and modeled the costs and savings associated with treatment of OUD, nationally and by state.

This research (1) characterized the prevalence of OUD, (2) modeled the costs of OUD, and (3) modeled the net cost impact of four ambulatory OUD treatments: (a) behavioral therapy alone, (b) behavioral therapy plus methadone, (c) behavioral therapy plus transmucosal buprenorphine, and (d) behavioral therapy plus long-acting injectable (LAI) buprenorphine.

Key Findings

OUD Prevalence: OUD cases per capita (the percentage of individuals per state with OUD) ranged from 0.75% to 2.99%. New Hampshire, Nevada, Massachusetts, and Kentucky had the highest rates of OUD (greater than 2.5%), while Wyoming, Hawaii, Washington DC, and Minnesota had the lowest (less than 1.0%).

Cost Burden of OUD: The total average annual cost per OUD case is approximately $695,000 across all stakeholders analyzed. The annual cost per OUD case, excluding the patient burden, is approximately $163,000, spread across public and private stakeholders. Including lost quality and length of life, the patient burden of OUD is approximately $532,000 per year.

In 2024, the burden of state and local government costs per capita across states ranged from $137 to $524 (Figure 1).

Figure 1. State and Local Government Cost of OUD Per Capita, 2024

Costs to External Stakeholders: Annual costs to the federal government, state/local governments, private businesses, and society at large are driven by lost productivity for employers ($438 billion), employees ($248 billion), and households ($73 billion). Health insurance and costs for uninsured care are $111 billion, criminal justice costs are $52 billion, and other substance use treatment costs are $12 billion (Figure 2).

Figure 2. Annual National Cost of OUD Excluding Patient Burden, 2024 ($ Billion)

Treatment Benefits of OUD: Medications and behavioral therapy to treat OUD are associated with significant average cost savings per case (Figure 3). Estimated annual per-case savings net of treatment cost from ambulatory treatments are estimated to be:

$144,000 for behavioral therapy alone

$271,000 for behavioral therapy plus methadone

$271,000 for behavioral therapy plus sublingual buprenorphine

$295,000 for behavioral therapy plus LAI buprenorphine

Figure 3. Cost Savings per OUD Case, Relative to Base Scenario, by OUD Treatment (95% Confidence Interval)

Funding for this research was provided by Indivior. Avalere Health retained full editorial control.

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